Provider Demographics
NPI:1871971044
Name:HEALTHCENTER NORTHWEST LLC
Entity type:Organization
Organization Name:HEALTHCENTER NORTHWEST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TATE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREITINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-751-6991
Mailing Address - Street 1:320 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3129
Mailing Address - Country:US
Mailing Address - Phone:406-756-4720
Mailing Address - Fax:406-751-5430
Practice Address - Street 1:320 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-756-4720
Practice Address - Fax:406-751-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0413644Medicaid
MT0413644Medicaid
MT27T087Medicare Oscar/Certification